TY - JOUR
T1 - Nephrectomy improves the survival of patients with locally advanced renal cell carcinoma
AU - Zini, Laurent
AU - Perrotte, Paul
AU - Jeldres, Claudio
AU - Capitanio, Umberto
AU - Pharand, Daniel
AU - Arjane, Philippe
AU - Lapointe, Steven
AU - Montorsi, Francesco
AU - Patard, Jean Jacques
AU - Karakiewicz, Pierre I.
PY - 2008/12
Y1 - 2008/12
N2 - OBJECTIVES: To examine the cancer-specific survival of patients treated with nephrectomy and compared it to that of patients managed without surgery. PATIENTS AND METHODS: Of 43 143 patients with renal cell carcinoma (RCC) identified in the 1988-2004 Surveillance, Epidemiology and End Results database, 7068 had locally advanced RCC and with no distant metastasis. These patients had a nephrectomy (6786, 96.0%) or no surgical therapy (282, 4.0%). Multivariable Cox regression models, and matched and unmatched Kaplan-Meier survival analyses, were used to compare the effect of nephrectomy vs non-surgical therapy on cancer-specific survival. Also, competing-risks regression models adjusted for the effect of other-cause mortality. Covariates and matching variables consisted of age, gender, tumour size and year of diagnosis. RESULTS: The 1-, 2-, 5- and 10-year cancer-specific survival of patients who had nephrectomy was 88.9%, 88.1%, 68.6% and 57.5%, vs 44.8%, 30.6%, 14.5% and 10.6% for non-surgical therapy. In multivariable analyses, relative to nephrectomy, non-surgical therapy was associated with a 5.8-fold higher rate of cancer-specific mortality (P <0.001). Non-surgical therapy was also associated with a 5.1-fold higher rate of cancer-specific mortality in matched analyses (P <0.001). Finally, competing-risks regression confirmed the statistical significance of the variable defining treatment type (nephrectomy vs non-surgical therapy) in multivariable and matched analyses (P <0.001). CONCLUSION: Relative to non-surgical treatment, nephrectomy improves the cancer-specific survival of patients with locally advanced RCC; our findings await prospective confirmation.
AB - OBJECTIVES: To examine the cancer-specific survival of patients treated with nephrectomy and compared it to that of patients managed without surgery. PATIENTS AND METHODS: Of 43 143 patients with renal cell carcinoma (RCC) identified in the 1988-2004 Surveillance, Epidemiology and End Results database, 7068 had locally advanced RCC and with no distant metastasis. These patients had a nephrectomy (6786, 96.0%) or no surgical therapy (282, 4.0%). Multivariable Cox regression models, and matched and unmatched Kaplan-Meier survival analyses, were used to compare the effect of nephrectomy vs non-surgical therapy on cancer-specific survival. Also, competing-risks regression models adjusted for the effect of other-cause mortality. Covariates and matching variables consisted of age, gender, tumour size and year of diagnosis. RESULTS: The 1-, 2-, 5- and 10-year cancer-specific survival of patients who had nephrectomy was 88.9%, 88.1%, 68.6% and 57.5%, vs 44.8%, 30.6%, 14.5% and 10.6% for non-surgical therapy. In multivariable analyses, relative to nephrectomy, non-surgical therapy was associated with a 5.8-fold higher rate of cancer-specific mortality (P <0.001). Non-surgical therapy was also associated with a 5.1-fold higher rate of cancer-specific mortality in matched analyses (P <0.001). Finally, competing-risks regression confirmed the statistical significance of the variable defining treatment type (nephrectomy vs non-surgical therapy) in multivariable and matched analyses (P <0.001). CONCLUSION: Relative to non-surgical treatment, nephrectomy improves the cancer-specific survival of patients with locally advanced RCC; our findings await prospective confirmation.
KW - Cancer-specific survival
KW - Conservative management
KW - Kidney neoplasm
KW - Locally advanced stage
KW - Natural history
KW - Renal cell carcinoma
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U2 - 10.1111/j.1464-410X.2008.07917.x
DO - 10.1111/j.1464-410X.2008.07917.x
M3 - Article
C2 - 18710442
AN - SCOPUS:56649117744
VL - 102
SP - 1610
EP - 1614
JO - BJU International
JF - BJU International
SN - 1464-4096
IS - 11
ER -